Human Physiology

Renal Physiology
Renal Physiology-Introduction
• Functional anatomy
• Blood Supply
• Loop of Henle physiology
• Innervation of Bladder
Functional Renal Anatomy
• The kidneys and micturition system are essential components of the urinary system, responsible for
maintaining homeostasis by regulating fluid balance, electrolyte concentrations, and waste excretion.

• The kidneys are paired, bean-shaped organs located retroperitoneally in the abdominal cavity, on either side
of the vertebral column.

• Situated between the T12 and L3 vertebrae, with the right kidney slightly lower than the left due to the
presence of the liver.
External Structure
• Each kidney is approximately 10–12 cm long, 5–7 cm wide, and 2–3 cm thick.

• Coverings

• Renal Capsule- A fibrous layer that surrounds the kidney, providing protection.

• Perirenal Fat- Adipose tissue surrounding the renal capsule, offering cushioning.

• Renal Fascia- A dense connective tissue layer anchoring the kidney to surrounding structures.

• Pararenal Fat- Outermost layer of fat, providing additional protection.

Externa
l
Structur
e
Internal Structure
• Divided into 2 parts

Renal Cortex Renal Medulla

Outer region Inner region

Renal corpuscles (Glomerulus) Renal Pyramids

Convoluted tubules (PCT, DCT) Collecting ducts and Loop of Henle

Blood filtration and initial urine formation Responsible for concentrating urine
Internal Structure
• Renal Columns: Extensions of cortical tissue separating the pyramids.

• Renal Papilla: Apex of each pyramid, opening into minor calyces.

• Calyces and Renal Pelvis

• - Minor calyces collect urine from the papilla.

• - Major calyces merge to form the renal pelvis, which transitions into the ureter.
Internal
Structu
re
Nephron
• The nephron is the structural and functional unit of the kidney, responsible for urine formation. Each kidney
contains about 1–1.5 million nephrons.
• Parts

Renal Corpuscle Renal Tubule

Glomerulus PCT
Bowman’s Capsule Loop of Henle
DCT
Collecting Duct
Nephr
on
Function
of
Nephron
Secretio
n and
Absorpti
on in
Nephron
Function
• Each nephron consists of a renal tubule.

• The renal tubule, in turn, is composed of a glomerulus enclosed by the Bowman’s

capsule, which is often described as a corpuscle.

• The glomerulus is an exquisite anatomical structure containing a group of capillaries

interposed between two arterioles.

• The vessel transporting blood to the glomerulus is known as the afferent arteriole; it
divides into 40–60 capillary loops, which then ultimately reunite to form the exit
pathway for the blood known as the efferent arteriole.

• Associated with the cells of the efferent arteriole is a cluster of cells known as the
juxtaglomerular or JG cells. The JG cells are the site of production of the
enzyme/hormone renin.
Function
• Bowman’s capsule constitutes the beginning of the renal tubule. Specialized
cells, termed podocytes, in Bowman’s capsule form slits or pores that
restrict and effectively prevent the passage of large protein macromolecules
in the blood into the top of the nephron.

• Thus, only ions and small organic molecules pass into the filtrate and are
selectively reabsorbed by the ascending limb of Henle’s loop, while any
small molecules that are retained in the ascending limb of Henle’s loop are
delivered to the distal convoluted tubule and are ultimately included in the
urine.

• The renal tubule is anatomically structured to permit countercurrent

distributive processes between its proximal convoluted tubule and the loop
of Henle and the distal convoluted tubule.
Function
• The nephron’s fundamental function is to regulate the concentration in the water of the
relatively soluble small molecules (e.g., ions, Na+, K+, Cl−, Ca2+, and Mg2+) and small
organic molecules (e.g., glucose, lactose, and peptides).

• The filtrate, as it enters the loop of Henle, becomes further concentrated by diffusion of
water from the inside of the descending loop of Henle into the adjacent “space”
(interstitium) outside of the descending loop of Henle.

• In the ascending limb of the loop of Henle, Na+ is actively transported out of the filtrate
(thereby diluting it) into the interstitium, where it is concentrated. The osmolarity of the
interstitial fluid can increase from 300 to 1200 mOsm/kg Hg as the papilla is
approached.

• Then, as the distal tubule passes back past the glomerulus additional Na + may be
reabsorbed in exchange for H+ or K+ ions. Eventually water is reabsorbed in the distal
tubule and collecting duct.
Role of Macula Densa cells
1. Sensing Sodium Chloride (Salt) Level
The macula densa cells monitor the concentration of sodium chloride (NaCl) in the fluid flowing through the distal tubule.
If NaCl levels are too high, it means the body is retaining too much salt, and the kidneys need to adjust.
2. Signaling the Glomerulus
When NaCl levels are high, the macula densa sends signals to the afferent arteriole.
This causes the afferent arteriole to constrict, reducing blood flow into the glomerulus and lowering the filtration rate
(tubuloglomerular feedback).
3. Regulating Blood Pressure
By controlling blood flow into the glomerulus, the macula densa helps regulate blood pressure and ensures the kidneys don’t
overwork.
4. Stimulating Renin Release
If NaCl levels are too low, the macula densa signals the juxtaglomerular cells(nearby cells in the afferent arteriole) to release
renin.
Renin is an enzyme that triggers a series of reactions (the renin-angiotensin-aldosterone system) to increase blood pressure and
restore salt balance.
Blood Supply of Kidney
• Kidneys receive 20-25% of cardiac output
• • Supplied by renal arteries (branches of abdominal aorta)
• • Unique portal circulation: glomerular capillaries → peritubular
capillaries/vasa recta
• • Essential for filtration, reabsorption, and secretion
Arterial Supply Overview
• • Renal Artery → Segmental Arteries → Interlobar Arteries
• • Arcuate Arteries → Interlobular Arteries → Afferent Arterioles →
Glomerulus
• • Glomerulus: filtration site
• • Efferent arterioles lead to peritubular capillaries (cortical nephrons)
or vasa recta (juxtamedullary nephrons)
Renal Artery
• • Arises from abdominal aorta at L1-L2 level
• • Right renal artery: longer, passes posterior to IVC
• • Divides into anterior and posterior divisions near hilum
Segmental and Interlobar Arteries
• • Segmental Arteries:
• - Apical, Upper, Middle, Lower, and Posterior
• - End arteries → No anastomosis → Damage causes infarction
• • Interlobar Arteries:
• - Travel between renal pyramids in renal columns
Arcuate and Interlobular Arteries
• • Arcuate Arteries:
• - Located at corticomedullary junction
• - Run parallel to kidney surface
• • Interlobular Arteries:
• - Branch off arcuate arteries → supply cortex
• - Give rise to afferent arterioles
Glomerular Circulation
• • Afferent Arteriole: brings blood to glomerulus
• • Glomerular Capillaries: site of filtration
• • Efferent Arteriole: exits glomerulus, leads to second capillary
network
Peritubular Capillaries & Vasa Recta
• • Peritubular Capillaries: surround PCT and DCT → involved in
reabsorption/secretion
• • Vasa Recta:
• - Specialized for juxtamedullary nephrons
• - Helps maintain osmotic gradient
Venous Drainage
• • Interlobular Veins → Arcuate Veins → Interlobar Veins → Segmental
Veins → Renal Vein → IVC
• • Left renal vein is longer → crosses anterior to aorta
• • Receives left gonadal, suprarenal, and inferior phrenic veins
Blood
suppl
y of
Kidne
y
Urinary Bladder and Micturition
Physiology
Introduction
• • Urinary bladder: Hollow muscular organ for urine storage and
release
• • Micturition: Process of urine expulsion
• • Coordinated by autonomic and voluntary neural control
Anatomy of the Urinary Bladder
• • Location: Pelvic cavity, posterior to pubic symphysis
• • Capacity: 300-500 mL
• • Layers:
• - Mucosa (transitional epithelium)
• - Submucosa (connective tissue)
• - Detrusor muscle (smooth muscle for contraction)
• - Adventitia/Serosa (outer covering)
Anatomy of the Urinary Bladder
• • Location: Pelvic cavity, posterior to pubic symphysis
• • Capacity: 300-500 mL
• • Layers:
• - Mucosa (transitional epithelium)
• - Submucosa (connective tissue)
• - Detrusor muscle (smooth muscle for contraction)
• - Adventitia/Serosa (outer covering)
Internal Features
• • Trigone: Triangle between ureteric orifices and internal urethral
orifice
• • Urethral sphincters:
• - Internal (involuntary, smooth muscle)
• - External (voluntary, skeletal muscle)
Nerve Supply
• • Sympathetic (Storage Phase): Hypogastric nerve (T11-L2)
• - Relaxes detrusor (β3) and contracts internal sphincter (α1)
• • Parasympathetic (Voiding Phase): Pelvic nerve (S2-S4)
• - Contracts detrusor (M3) and relaxes internal sphincter
• • Somatic: Pudendal nerve (S2-S4) for voluntary control
Physiology of Micturition
• • Storage Phase:
• - Sympathetic activation → Detrusor relaxed, sphincters closed
• - External sphincter contracted (voluntary control)
• • Voiding Phase:
• - Parasympathetic activation → Detrusor contracts, sphincters relax
• - Urine expelled under voluntary and reflex control
Reflex Control of Micturition
• • Infantile Reflex:
• - Spinal reflex (S2-S4), involuntary
• • Voluntary Control:
• - Pontine Micturition Center (PMC) coordinates voiding
• - Frontal cortex inhibits urination until appropriate
Clinical Correlations
• • Neurogenic Bladder Disorders:
• - Spinal cord injury above S2 → Reflex bladder (involuntary
contractions)
• - Below S2 → Atonic bladder (urinary retention)
• • Urinary Incontinence:
• - Stress: Weak sphincter (leakage on exertion)
• - Urge: Overactive detrusor muscle
• - Overflow: Chronic retention with dribbling
Benign Prostatic Hyperplasia (BPH)
• • Enlarged prostate obstructs urine outflow
• • Causes difficulty in urination and incomplete bladder emptying
• • Common in elderly men
Summary
• • Urinary bladder stores and expels urine
• • Micturition is controlled by autonomic and voluntary mechanisms
• • Disorders like neurogenic bladder, incontinence, and BPH affect
urination
Bladder
Physiolo
gy